The effect of intraocular lens tilt on visual outcomes in scleral-fixated intraocular lens implantation

  • Burcu Kemer AtikEmail author
  • Cigdem Altan
  • Alper Agca
  • Asli Kirmaci
  • Yusuf Yildirim
  • Selim Genc
  • Muhittin Taskapili
Original Paper



To investigate the effect of scleral-fixated intraocular lens (IOL) tilt on visual outcomes.


Ninety-four eyes of consecutive 94 patients who underwent scleral-fixated IOL implantation with Z-suture technique were included in this prospective study. The values of pre- and postoperative 12th month uncorrected visual acuity (UCVA), cylindrical refractive error, best-corrected visual acuity (BCVA) and corneal and lenticular astigmatism were recorded. The position of the implanted IOL was evaluated with anterior segment optical coherence tomography (AS-OCT). The relationships between the AS-OCT measurements and the visual acuity or refractive errors were investigated.


The IOL position was evaluated as tilted in 68 (72.3%) patients: 29 (30.8%) in both vertical + horizontal axes, 30 (31.9%) in the horizontal axis and 9 (9.6%) in the vertical axis. There were no significant differences between patients with and without tilt IOL position in terms of the UCVA, BCVA, cylindrical refractive error and lenticular astigmatism (p > 0.05, for each). The mean BCVA was significantly higher in the no-tilt group than in the both horizontal + vertical tilt and the vertical tilt groups (p = 0.03, p = 0.04, respectively). The mean lenticular astigmatism was significantly higher in the vertical tilt group than the other groups (p = 0.04).


Tilting in IOL position occurs commonly; however, IOLs with tilting on any of the axes do not have significantly worse outcomes when compared with IOLs with no tilt, in terms of visual results and refractive errors. On the other hand, tilting on the vertical axis is observed less commonly, yet is more effective on visual results and refractive errors, when compared with tilting on the horizontal axis.


Anterior segment OCT Aphakia Secondary intraocular lens implantation Scleral fixation Tilt of intraocular lens Z-suture technique 


Supplementary material

10792_2019_1233_MOESM1_ESM.avi (68.9 mb)
Video-1: Scleral fixation surgery video with Z-suture technique applied to one of our patients. Firstly, dissection of conjunctiva and tenon and cauterization of superficial conjunctival vessels were performed. 10–0 polypropylene-looped suture with a long curved needle (PC-9; Alcon Surgical, Fort Worth, TX) was passed through the cartridge. The suture was tied to one of the haptics of the three-piece IOL. Anterior vitrectomy was performed before suturing the IOL, if vitreous prolapsus was present. The needle was passed through the ciliary sulcus, perforating the sclera at approximately 1.5 mm distance to the limbus. The IOL was injected into the anterior chamber using the cartridge, but the other haptic was not injected. The suture was tied to the other haptic, which was left outside. The needle was passed from the ciliary sulcus through the sclera about 1.5 mm to the limbus. The scleral fixation points were 180 degree diagonally apart (12–6 o’clock meridians). Then transscleral suturation was performed with the Z-suture technique. This patient has aphakic left eye due to complicated cataract surgery. The preoperative best-corrected visual acuity was 0.2. At postoperative 12th month, best-corrected visual acuity was 0.1 and IOL position was evaluated as ‘no tilt’ with anterior segment OCT (AVI 70,594 kb).


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Gaziosmanpasa Training and Research Hospital, University of Health SciencesIstanbulTurkey
  2. 2.Beyoglu Eye Training and Research Hospital, University of Health SciencesIstanbulTurkey

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